Background Efficiently caring for frail, older adults will become an increasingly important part of healthcare reform; telemonitoring within homes may be an answer to improve outcomes. This study sought to determine the difference in hospitalizations and emergency room (ER) visits in older adults using telemonitoring versus usual care. Methods This was a randomized trial of adults older than 60 years with high-risk for rehospitalization. Subjects were randomized to telemonitoring with daily input versus patient-driven usual care. Telemonitoring was accomplished by daily biometrics, symptom reporting and videoconference. The primary outcome included a composite end-point of hospitalization and ER visits in the 12 months following enrollment. Secondary end-points included hospital days, hospital admissions, and ER visits. Intention to treat analysis was performed. Results Two hundred and five subjects were enrolled with a mean age of 80.3 years. There was no difference in hospitalizations and ER visits between the telemonitoring group (63.7%) and the group receiving usual care (57.3%) (P value 0.345). There was no difference in individual outcomes including hospital days, hospital admissions and ER visits. There also was no significant change between hospitalizations and ER visits in the pre-enrollment and post-enrollment period. Mortality was higher in the telemonitoring group (14.7%), compared to usual care (3.9%) (P value 0.008). Conclusions Among elderly patients, telemonitoring did not result in lower hospitalizations or ER visits. There were no differences determined within the secondary outcomes. The cause of the mortality difference is unknown.

Logistic regression based classifiers yield only moderate performance when utilized to predict 30-day readmissions. The task is difficult due to the variety of underlying causes for readmission, nonlinearity, and the arbitrary time period of concern. More sophisticated classification techniques may be necessary to increase performance and allow patient centered medical homes to effectively focus efforts to reduce readmissions.

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Most eVisits for minor acute illnesses can be completed without any further interaction with the healthcare system.

Purpose: The chronic disease model suggests continuity of care and team-based care can improve outcomes for multimorbidity patients and reduce hospitalizations. Continuity of care following admission has had mixed effects on readmission rates; however, its effect before admission has not been well studied. Increased outpatient care organization and continuity before admission is hypothesized to reduce the odds of readmission.Methods: In a cohort of 14,662 primary care patients from a Patient-Centered Medical Home (PCMH) practice, continuity of care in the 12 months before admission was assessed using 3 established metrics; usual provider continuity (UPC), dispersion continuity of care (COC), and sequence continuity (SECON). In addition, because these established metrics may not accurately reflect continuity in planned teambased care, a new metric called visit entropy (VE) was used to quantify the disorganization of visits. Multivariate logistic regression was performed to examine the relationship between readmission within 30 days and continuity while controlling for known readmission risk factors abstracted from an electronic medical record.Results: Higher VE was associated with readmission (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19). The continuity measures of UPC, COC, and SECON were not associated with readmission.

BackgroundOlder adults with multiple chronic illnesses are at risk for worsening functional and medical status and hospitalization. Home telemonitoring may help slow this decline. This protocol of a randomized controlled trial was designed to help determine the impact of home telemonitoring on hospitalization. The specific aim of the study reads as follows: to determine the effectiveness of home telemonitoring compared with usual care in reducing the combined outcomes of hospitalization and emergency department visits in an at-risk population 60 years of age or older.Methods/DesignTwo-hundred patients with the highest 10% Mayo Clinic Elder Risk Assessment scores will be randomly assigned to one of two interventions. Home telemonitoring involves the use of a computer device, the Intel Health Guide, which records biometric and symptom data from patients in their homes. This information is monitored by midlevel providers associated with a primary care medical practice. Under the usual care scenario, patients make appointments with their providers as problems arise and use ongoing support such as a 24-hour nurse line.Patients will have initial evaluations of gait and quality of life using instruments such as the SF-12 Health Survey, the Kokmen Short Test of Mental Status, and the PHQ-9 health questionnaire. Patients will be followed for 1 year for primary outcomes of hospitalizations and emergency department visits. Secondary analysis will include quality of life, compliance with the device, and attitudes about telemonitoring. Sample size is based on an 80% power to detect a 36% difference between the two groups. The primary analysis will involve Cox proportional time-to-event analysis. Secondary analysis will use t-test comparisons for continuous variables and the chi square test for proportional analysis.DiscussionPatients randomized to home telemonitoring will have daily assessments of their health status using the device. Registered nurse monitoring will assess any change in status followed by videoconferencing by a mid-level provider. We obtained trial registration and Institutional Review Board approval.Trial registrationTrial registration number through http://www.clinicaltrials.gov: NCT01056640.

Elderly patients find home telemonitoring to be an acceptable and satisfying experience that can increase their awareness of their health and provide a sense of safety in their home. Home telemonitoring can lead to earlier evaluation of decline in health status.